Title

Clinical Course of Patients in Cardiogenic Shock Stratified by Phenotype.

Authors

Elric Zweck
Manreet Kanwar
Song Li
Shashank S Sinha
A Reshad Garan
Jaime Hernandez-Montfort
Yijing Zhang
Borui Li
Paulina Baca
Fatou Dieng
Neil M Harwani
Jacob Abraham, Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph HealthFollow
Gavin Hickey
Sandeep Nathan
Detlef Wencker
Shelley Hall
Andrew Schwartzman
Wissam Khalife
Claudius Mahr
Ju H Kim
Esther Vorovich
Evan H Whitehead
Vanessa Blumer
Ralf Westenfeld
Daniel Burkhoff
Navin K Kapur

Document Type

Article

Publication Date

6-6-2023

Publication Title

JACC Heart Fail

Keywords

oregon; cards; cards publication; SCAI stages; acute heart failure; cardiogenic shock; machine learning; mechanical circulatory support; outcomes; phenotypes

Abstract

BACKGROUND: Cardiogenic shock (CS) patients remain at 30% to 60% in-hospital mortality despite therapeutic innovations. Heterogeneity of CS has complicated clinical trial design. Recently, 3 distinct CS phenotypes were identified in the CSWG (Cardiogenic Shock Working Group) registry version 1 (V1) and external cohorts: I, "noncongested;" II, "cardiorenal;" and III, "cardiometabolic" shock.

OBJECTIVES: The aim was to confirm the external reproducibility of machine learning-based CS phenotypes and to define their clinical course.

METHODS: The authors included 1,890 all-cause CS patients from the CSWG registry version 2. CS phenotypes were identified using the nearest centroids of the initially reported clusters.

RESULTS: Phenotypes were retrospectively identified in 796 patients in version 2. In-hospital mortality rates in phenotypes I, II, III were 23%, 41%, 52%, respectively, comparable to the initially reported 21%, 45%, and 55% in V1. Phenotype-related demographic, hemodynamic, and metabolic features resembled those in V1. In addition, 58.8%, 45.7%, and 51.9% of patients in phenotypes I, II, and III received mechanical circulatory support, respectively (P = 0.013). Receiving mechanical circulatory support was associated with increased mortality in cardiorenal (odds ratio [OR]: 1.82 [95% CI: 1.16-2.84]; P = 0.008) but not in noncongested or cardiometabolic CS (OR: 1.26 [95% CI: 0.64-2.47]; P = 0.51 and OR: 1.39 [95% CI: 0.86-2.25]; P = 0.18, respectively). Admission phenotypes II and III and admission Society for Cardiovascular Angiography and Interventions stage E were independently associated with increased mortality in multivariable logistic regression compared to noncongested "stage C" CS (P < 0.001).

CONCLUSIONS: The findings support the universal applicability of these phenotypes using supervised machine learning. CS phenotypes may inform the design of future clinical trials and enable management algorithms tailored to a specific CS phenotype.

Clinical Institute

Cardiovascular (Heart)

Department

Cardiology

Recommended Citation

Zweck, Elric; Kanwar, Manreet; Li, Song; Sinha, Shashank S; Garan, A Reshad; Hernandez-Montfort, Jaime; Zhang, Yijing; Li, Borui; Baca, Paulina; Dieng, Fatou; Harwani, Neil M; Abraham, Jacob; Hickey, Gavin; Nathan, Sandeep; Wencker, Detlef; Hall, Shelley; Schwartzman, Andrew; Khalife, Wissam; Mahr, Claudius; Kim, Ju H; Vorovich, Esther; Whitehead, Evan H; Blumer, Vanessa; Westenfeld, Ralf; Burkhoff, Daniel; and Kapur, Navin K, "Clinical Course of Patients in Cardiogenic Shock Stratified by Phenotype." (2023). Articles, Abstracts, and Reports. 7477.
https://digitalcommons.providence.org/publications/7477